Clinical evaluation of a pressure release valve for paediatric cuffed tracheal tubes

Objective. The safe use of cuffed tracheal tubes for children necessitates a cuff pressure limitation at 20-25 cmH(2)O. The aim of the study was to evaluate the reliability and benefit of a new cuff pressure release valve (opening pressure 20cmH(2)O) for children intubated with a cuffed tracheal tube. Methods. In a prospective, observational trial cuff pressure was recorded in paediatric and adolescent patients intubated with a cuffed tracheal tube during sevoflurane/nitrous oxide anaesthesia. The cuff pressure release valve was interposed between the cuff manometer and the pilot balloon. In 25 patients measurements were started at the initial opening pressure (group A) and in a further 25 patients measurements were started at the minimal sealing cuff pressure (group B). Results. A total of 50 patients, aged from 0.4 to 17.8 years (median 7.4 years) were enrolled in the study. The opening pressure measured (group A) was 19.7 +/- 0.8 cmH(2)O and the cuff sealing pressure (groupB) was 11.7 +/- 2.9 cmH(2)O (range 6-16 cmH(2)O). Mean cuff pressure values in groupA were 20.4 +/- 1.6 cmH(2)O and 16.5 +/- 3.3 cmH(2)O in groupB. In one patient (groupA) the cuff pressure exceeded 25 cmH(2)O and was manually decreased to 20 cmH(2)O. In total, 24 filling procedures (groupA 14; groupB 10) were required during 103.1h of investigation because of cuff pressure drop and audible air leakage, mainly caused by cuff pressure increases and consequent releases during patient positioning. Conclusion. Our data demonstrate that the tested cuff pressure release valve was useful and reliable to limit cuff pressure in tracheal intubated children and adolescents within an acceptable pressure range.